Research indicates that teachers' conceptions of and approaches to teaching with technology are central for the successful imple-mentation of educational technologies in higher education. This study advances this premise. We present a 10-year longitudinal study examining teachers' conceptions of and approaches to teaching and learning with technology. Nine teachers on an online Bachelor of Science in Pharmacy and a Master of Pharmacy programme at a Swedish university were studied using a phenomenographic approach. Results showed clear differences between novice and experienced teachers. Although novice teachers initially held more teacher-focused conceptions, they demonstrated greater and more rapid change than experienced colleagues. Experienced teachers tended to exhibit little to no change in conceptions. Supporting conceptual change should, therefore, be a central component of professional development activities if a more effective use of educational technology is to be achieved.